Position the Patient

Patient supine with arm out and entire arm exposed

Identify the Vein

Using ultrasound

Non-pulsating, collapsible vessel

Estimate Insertion Length

Usually 45 - 50cm

Measure from sternal angle to sternal notch then down arm to insertion site

Prepare Sterile Field

Open all required sterile equipment onto field

Prepare the Site

Decontaminate a large area with chlorhexidine

Place the Drape

Expose the decontaminated site and cover everything else

Prepare Equipment

Draw up local, place everything in the order it will be used

Prepare the PICC Line

Place bungs on all lumens except central lumen, flush each lumen

Identify the Vein

Using ultrasound

Non-pulsating, collapsible vessel

Inject Local Anaesthetic

Create a small wheal over the insertion site

Remove the Needle

While holding onto guidewire, apply pressure to site using gauze

Make an Incision

Using the scalpel, make a small incision adjacent to the guidewire

Use the Dilator

While holding the guidewire, insert then remove the dilator

Position the Patient

To avoid jugular placement

Arm abducted, chin on ipsilateral shoulder

Introduce the PICC

Gently, while holding onto the guidewire, to premeasured length

Remove the Guidewire

Fix the PICC

Suture or use adhesive fixation device

Dress the Site

Using sterile, transparent occlusive dressing

Document

Confirm the PICC Position

Using chest x-ray

Alcohol Swab

Rub all sides of the port for >20sec

Aspirate

Until blood aspirated - 5-10mL

Access

Withdraw blood or give medication as required

Flush

With 10mL of 0.9% NaCl

Dress

With gauze and transparent dressing

Check

PICC integrity and length